Burge Frederick I, Bower Kelly, Putnam Wayne, Cox Jafna L
Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia.
Can J Cardiol. 2007 Apr;23(5):383-8. doi: 10.1016/s0828-282x(07)70772-9.
The Canadian Cardiovascular Outcomes Research Team was established in 2001 to improve the quality of cardiovascular care for Canadians. Initially, quality indicators (QIs) for hospital-based care for those with acute myocardial infarctions and congestive heart failure were developed and measured. Qualitative research on the acceptability of those indicators concluded that indicators were needed for ambulatory primary care practice, where the bulk of cardiovascular disease care occurs.
To systematically develop QIs for primary care practice for the primary prevention and chronic disease management of ischemic heart disease, hypertension, hyperlipidemia and heart failure.
A four-stage modified Delphi approach was used and included a literature review of evidence-based practice guidelines and previously developed QIs; the development and circulation of a survey tool with proposed QIs, asking respondents to rate each indicator for validity, necessity to record and feasibility to collect; an in-person meeting of respondents to resolve rating and content discrepancies, and suggest additional QIs; and recirculation of the survey tool for rating of additional QIs. Participants from across Canada included family physicians, primary care nurses, an emergency room family physician and cardiologists.
31 QIs were agreed on, nine of which were for primary prevention and 22 of which were for chronic disease management.
A core set of QIs for ambulatory primary care practice has been developed as a tool for practitioners to evaluate the quality of cardiovascular disease care. While the participants rated the indicators as feasible to collect, the next step will be to conduct field validation.
加拿大心血管结局研究团队于2001年成立，旨在提高加拿大人心血管护理的质量。最初，针对急性心肌梗死和充血性心力衰竭患者的医院护理质量指标（QIs）被制定并进行了测量。关于这些指标可接受性的定性研究得出结论，门诊初级护理实践也需要指标，因为大部分心血管疾病护理都在此进行。
系统地制定用于初级护理实践的质量指标，以用于缺血性心脏病、高血压、高脂血症和心力衰竭的一级预防和慢性病管理。
采用四阶段改良德尔菲法，包括对循证实践指南和先前制定的质量指标进行文献综述；开发并分发包含拟议质量指标的调查工具，要求受访者对每个指标的有效性、记录必要性和收集可行性进行评分；召开受访者面对面会议，以解决评分和内容差异问题，并提出其他质量指标；再次分发调查工具，对其他质量指标进行评分。来自加拿大各地的参与者包括家庭医生、初级护理护士、急诊室家庭医生和心脏病专家。
共商定了31项质量指标，其中9项用于一级预防，22项用于慢性病管理。
已制定了一套门诊初级护理实践的核心质量指标，作为从业者评估心血管疾病护理质量的工具。虽然参与者认为这些指标在收集方面是可行的，但下一步将进行实地验证。
